Premature Ejaculation

Premature ejaculation is considered by most urologists to be the leading form of male sexual dysfunction, affecting about 30 percent of men of all ages. Premature ejaculation has various definitions ranging from ejaculating within one minute of vaginal penetration to ejaculating prior to a man's partner achieving orgasm or general sexual satisfaction.

The exact cause of premature ejaculation is not well known. Studies have shown a variety of factors alone or in combination may contribute to premature ejaculation including:

Psychological
Premature ejaculation can be caused by temporary depression, stress or anxiety about a relationship, unrealistic expectations about performance or a history of sexual problems.

Biological
A number of biological factors could be the cause of premature ejaculation including abnormal hormone levels, abnormal reflex activity of the ejaculatory system, hyperthyroidism or inflammation or infection of the prostate or urethra.

Neurobiological
It is believed that the neurotransmitter serotonin (5HT) plays a central role in controlling ejaculation. Low levels of serotonin in specific areas of the brain may cause premature ejaculation. Studies have shown that increases in serotonin levels can help delay ejaculation in some men.

Penile Sensitivity
Many physicians believe that penile hypersensitivity plays a predominant role in the ejaculatory response while others believe that premature ejaculation is the result of a combination of multiple contributing factors. The success of topical (applied to skin) medications provides strong reason to believe that penile sensitivity does contribute to premature ejaculation.

Diagnosis
A premature ejaculation diagnosis begins with:

  • Education - description of the potential psychological, biological, neurobiological and penile sensitivity causes of premature ejaculation.
  • Health issues – premature ejaculation is rarely caused by a biological health condition, but this can be determined following a basic health history.
  • Relationship issues - past or current relationship issues may be a cause of premature ejaculation.
  • Physical Examination - examination of the genital area is typically not required.

Treatments:

Behavioral therapy - Some patients respond to techniques such as starting and stopping. Although effective at times, most patients report limited sexual satisfaction with these methods.

  • Topical medications - Topical anesthetic medications are typically the first treatment option for premature ejaculation. They are effective, easy-to-use, low-cost and have a negligible risk of systemic side effects.
  • One option for patients is a new product, Promescent®, from Absorption Pharmaceuticals, which provides improved ejaculatory latency (the time from penetration to ejaculation) with minimal loss of sexual sensation.
  • Oral medications - Some men respond well to low doses of the antidepressants known as selective serotonin reuptake inhibitors (SSRIs). These are prescribed off-label, with some side effects.